Diverticulosis is generally discovered through one of the following examinations:
It is not known whether diverticulosis can be prevented. Constipation, a major cause of excess intra-colonic pressure and thought to be responsible for some cases of diverticulosis, should be avoided. A diet rich in fiber (bran cereals, whole wheat breads, fresh fruits, and leafy vegetables) may decrease the development of diverticulosis, improve symptoms of constipation and decrease the likelihood of complications. Benefits of a high fiber diet may be seen in those who eat between 15 and 30grams of fiber a day. Unfortunately people in the United States generally only consume 8-12 grams a day. Diverticulosis does not appear to be associated with alcohol, smoking or caffeine consumption.
Once diverticula have formed they do not go away. For those who do not have symptoms, increasing fiber in the diet to soften and bulk the stool may decrease the development of more diverticula, or prevent complications. Ask your doctor if you have special concerns.
Persons with diverticulosis are sometimes instructed to avoid foods that contain undigestible particles such as popcorn, nuts and fruits with small seeds. The theory of such a diet is that these particles might get "caught" in a diverticulum and precipitate diverticulitis. Proof of effectiveness for such a diet is lacking and only anecdotal stories support this restricted diet for patients.
Other complications of diverticulitis include development of an abscess or narrowing of the colon (stricture). Rarely one can develop a "fistula" or connection between the bowel and bladder as a complication of diverticulitis.
Hemorrhage or the passage of large amount of bright red blood from the rectum in most cases is due to diverticulosis. It occurs typically without warning and is painless. Severe bleeding has been reported in 3-5% of people with diverticulosis and usually stops without special treatment. Endoscopic examination of the colon may be necessary to diagnose and treat the cause of bleeding. Nuclear medicine bleeding scans can also be used to identify the site of the diverticular bleeding in cases where endoscopy does not reveal the active site. Occasionally angiography (injection of dye into the blood vessels) performed by a radiologist is needed to identify and treat diverticular bleeding. In cases where endoscopic or radiologic management fails to control the bleeding, surgery may be necessary to remove the involved area.
Treatment for diverticulitis (an inflamed or infected diverticulum) requires the use of antibiotics and occasionally hospitalization. Recovery is usually uneventful, however if a pericolonic abscess persists radiologic drainage via percutaneous catheter can drain and help remove the abscess. Surgery is rarely required but may be needed for cases that don't respond to medical management. A temporary colostomy may be required during surgery for complicated diverticulitis.
Ernst Bontemps, MD and Peter M. Pardoll, MD, FACG, Center for Digestive Diseases, South Pasadena, FL – Published June 2004, Updated September 2008.